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Chest Pain After Sexual Intercourse

Case Editor - Kamyar Afshar

Reviewed By Critical Care Assembly

Submitted by

Nitin Seam, MD

Attending Physician, Pulmonary/Critical Care Section

Veterans Affairs Medical Center

Washington, D.C.

PK Rohatgi, MD

Chief of Pulmonary/Critical Care Section

Veterans Affairs Medical Center

Washington, D.C.

Submit your comments to the author(s).

History

A 55-year-old man presented to the Emergency Department 1 hour after developing chest pain.

He described the pain as severe, sharp, left-sided, and abrupt in onset with radiation to his back.  He reported that the pain started during sexual intercourse concurrent with an episode of vomiting.   He denied any other episodes of nausea or vomiting. He also denied diarrhea, cough, fevers, chills, or recent trauma.

Past Medical History: Significant for HIV without any history of opportunistic infections, as well as gout, hypertension, and insulin-dependent diabetes mellitus.

Social History:  Significant for 10-pack-year history of cigarette smoking and intake of two alcoholic beverages per week.

Lab

WBC 11,100/cubic millimeter with 88.1% neutrophils
            Hemoglobin 15.6 g/dL

Platelets 82,000/cubic millimeter

            Sodium 141 mmol/L

            Potassium   3.5 mmol/L

            Chloride  107 mmol/L

            Bicarbonate 23 mmol/L

            Blood Urea Nitrogen  17 mg/dL

            Creatinine 1.5 mg/dl

            Amylase 122 U/L

            Alkaline phosphatase 46 mU/ml

           Asparate Aminotransferase  40 U/L

           Alanine Aminotransferase  28 U/L

           Total bilirubin 1.1 mg/dL

Albumin 4.6 g/dL

           Arterial blood gas on 2 liters per minute of supplemental oxygen by nasal cannula: pH=7.43, PaCO2=35 mmHg, PaO2=58 mmHg

Figures


Figure 1. Portable Chest Radiograph

Figure 2. Follow-up Portable Chest Radiograph

Figure 3. Esophogram

Figure 4. Computed Tomogram (CT) of the Chest

Question 1

What abnormalities are visible on the chest radiograph shown in Figure 1?


References

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